B-2017-1973 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: ' PERMIT NO:B-2017-1973
11062 CLARKSTON AVE CUPERTINO,CA 95014-4780(356 20 037) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD •
' VALENCIA,CA 91355
•
OWNER'S NAME: YOUNG MING HUEI AND MING-CHIAO A TRUSTEE DATE ISSUED: 11/15/2017 •
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OWNER'S PHONE: PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#627368
, Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG. _ELECT X PLUMB
09/30/2018 _MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that II am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license is in full force and effect. (N)40 GALLON WATER HEATER-INSIDE CLOSET
' I hereby affirm under penalty of perjury one of the following two declarations: •
1. I have and will.maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for Sy.Section 3700 of the Labor Code,for the -
,-•rformance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
- Section 3700 of the'Labor Code,'for'the performance of the work for which this. Sq.Ft Floor Area: Valuation:$2981.00
permit is issued. .
APPLICANT C •
ERTIFICATION
-
I certify that I have read this application;and state that the above APN Number: • Occupancy Type:
information is correct.I agree to comply:with all city and county ordinances 356 20 037
and state laws relating to building construction,and hereby authorize
representatives of this citydo enter upon the above mentioned property for
inspection purpose4.• (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which. WITHIN 180 DAYS OF PERMIT ISSUANCE,OR
• may accrue a.-mat said.City in consequence of the granting of this permit.
Additionally,t p. .-nt understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulate./ Cupertino Municipal.Code,Section 9.18.
Issued by:Jasmine Archbold
ature \ Date 10/15/2017 Date: 11/15/2017
•
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OWNER-BUILD Li•_ ECLARATION RE-ROOFS:
I hereby affirm that I am exempt from'the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: '' • ' installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owneiof the property,or,my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for •
sale,(Sec.7044,Business,&Professions Code) Signature of Applicant:
2, I,as owner of the property,ani exclusively contracting with licensed Date: 10/15/2017
contractor's to construct the project(Sec.7044,Business&Professions Code).
•I hereby affirm under penalty of,perjui-y one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain'a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work,for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain'Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections'25505,25533,and 25534. I will
Section 3700 of,the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
'IHealth&Safety Code,Section 25532(a)'should I store or handle hazardous
permit is issued: '
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the I .rea Air Quality Management District I
• will maintain compliance with the ,upe ino Municipal Code,Chapter 9.12 and
Worker's Compensation'laws ofCalifornia. If,after making this certificate of the Health&Safety Cor• ectio s 25505/k \ . 1 i ,25533,and 25534. '
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall
I 0„mph.r authorized agent: • i 1 I
be deemed revoked .; i,; ®:.-710/15/2017 1 I
[APPLICANT CERTIFICATION ONSTRU ellk L NDING AGENCY
I certify that I have read this application'and state that the above information is I hereby affirm that there is a co tion lending agency for the performance
correct.I agree to comply with all city rand county ordinances and state laws of work's for which this permit is i d;(Sec.3097,Civ C.)
relating to building construction,end h'ei.eby authorize representatives of this city Lender's Name i '
to enter upon the above mentioned'property for inspection purposes. (We)agree
to save indemnify and keep har• mless�th;e City of Cupertino against liabilities, Lender's Address. ,
judgments,costs,and expenseelwhich;may accrue against said City in ' ':
consequence of the granting of,this permit. Additionally,the applicant understands ARCHITECT'S DECLARATIO
and will comply with all 'nom-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
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CONSTRUCTION PERMIT APPLICATION
X COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
- 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
:Y xct'T.ia : �
(408) 777-3228 • building@cupertino.org PEMIT#B- Z.0 [L- ��(,7j
CUPERTINO +� REV# DEFT
1-: NEW CONSTRUCTION ❑ADDITION [1]ALTERATION ❑T.J. ,1'�f MEP ElRE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS Irt 0 / In /9 f�,/rJ„ A`PN a 5—c 7Z---0 CD 3
OWNER NAME nA��5 rrz�n 1 PHONE I E-MAIL
STREET ADDRESS_� I /1 j_�.__..4��'lY�� - _._�__AcT1
" is-*
ii � _..___.._..__.__
t -CONTiRACTORNAMEI�Nk/a❑�JOWNER-BUILDER C MPANYNAME . - LICENSE NUMBERLICENSE TYPE '
j ..1r.
9 4., „..s -36,1- c- ;T(p
CITY, TE, ZIP fr E SS 60/1 061
( r�=1 nci4
1 cM - 13.cs^ .
E-MAH PHOVIE i A BUS.LSC I
❑A CHITEC'IU]OWNER.❑OWNER AGEN ❑CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT •
CONTACT NAME E-MAIL
,-, STREET ADDRESS , CITY,STATE,ZIP PHONE ,
•
DECRIPl ONI. rpqc47)47 -4-d 1/V c/` 63)-- /I- /-e4 c_ca , I 0�'� °
L -1 .
. • (/-]ail- • ,
r MOLE-FAMILY/DUPLEX, 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF, NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET 5F USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL OTHR • GARAGE 0 ATTACHED
BATHROOM SF • 5F SF SF , 0 DETACHED
i EXISING I DYES EICHLER 0 IES SECOND. STORY ADDITION DYES
FIRE SPRINKLERS 0 NO 0 NO
'DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER
(UNITS:1 UNIT ADDITON: ,-D:No S F
!POOLS ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
I POOL--SF SPA-SF I',SPA ATTACHED❑YES 0 NO I TOTAL-SF
• (`RECEIVED BY:
! TOTAL VALUATION:
1 Commercial or Multi-Faniihr Buildfrrs with Pirhlir Swinuviu¢Pools remrires Department of Ennirmvaenhr!Heath annronal l �' q y� a
I . , i J /C,t
RE-RO'OF EXISTING ROOF TYPE; 0 BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER( ECIrrl')
I REMOVE REP:ACE D NO' IF NO ' PLYWOOD ❑1" ❑3/B"" ' PLYWOOD TYPE: PITCH: ROOF CLASS
I
HI ' ❑YES f OF LAYERS - THICKNESS❑518" OTHER ❑OSB ❑CDX OTHER :12 A
!PROPOSED ROOF TYPE,❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER
"Provide•a signed copy of the Cupertino's Tear-Off Policy SF ;of SQUARES
1 By my signature below I.certify to each of the-following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this applica',tion and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply With all applicable local ordi,an -nd state lace's relating to building construction. I authorize represeantatives of Cupertino to
enter the abov e Identified property for i-s ti urposes. I acknowledge and authorize all information c ntaine On this application form
to be made a� ilable for}public record. ,- / 5 /'
,Signature of Applicant/Agent: Date: -
SUPPLEMENTAL INFORMATION RES UI`. ED - '
*New OD/Second Dwelling,Urvts/Multi = '+y Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
"Commercial;Buildings:,P oside a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
'.'Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. •
';HOA-Provide a letter'of approvalfrom the Home Owner's Association
BldgApp_2017.doc revised 08,01/17
. ► Fi
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTIN1 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
--,
(408)777-3228•FAX(408)777-3333•buildina a(�cupertino.orq-
PERNIIT CANNOT BE FINALE))UNTIL THIS CtRTI CATS:AAS BEEl�I
tOMPT.ETED,SiGNED.,/ND.ItE 12NED TO j E BT33I,*GNG DIVES3ON
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and_Carbon_ _
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000 00, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations
AREA SMOKE ALARM CO ALARM
Outside-of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below
Address. 1 •#'' I Permit No. 1 p
99,
Specify Number of Alarms #Smoke Alarms 1 #Carbon Monoxide Detectors. J { 1
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
)/W11/1,00
)) 6a 1c i \-/()`�� 6Signature . . Date: .... :./....
Contractor Name: i/
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017